Paramedic Chief

How Pittsburgh’s ‘Freedom House’ shaped modern EMS systems

During a time of racial tension and social upheaval, the movement helped form the foundations of the pre-hospital care we’re used to today

If you look closely at Pittsburgh EMS ambulances, you might see an emblem commemorating “Freedom House,” an ambulance service that responded to medical emergencies in an impoverished section of the city from 1968 to 1975.

Yet Freedom House might have been a mere footnote in the annals of EMS history, if not for a paramedic-turned-documentary filmmaker and a group of former Freedom medics dedicated to keeping the memory of Freedom House alive.

At a time of racial tension and social upheaval, Freedom House was a cutting-edge experiment in prehospital care that helped break down racial barriers and shape the development of a fledgling EMS system in America. Trained by Peter Safar, M.D., known as the “father of CPR,” Freedom House medics were among the first to treat cardiac arrest with chest compressions, rescue breathing and intubation outside of a hospital, and to travel with EKGs and a variety of medications to administer on scene.

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Even 40 years later, the story of the young black men and women trained to become emergency responders for a community in desperate need of services, trained by a handful of pioneering doctors who were among the first to believe in high-quality pre-hospital care, still resonates.

“It was so far ahead of its time,” says John Moon, a Freedom House medic who eventually became assistant EMS chief in Pittsburgh until his retirement in 2009. “It was inconceivable at that time for someone to come to your door and start an IV on you, or intubate you and give you cardiac drugs and start CPR. Outside the hospital, this had never been done.”

A racially divided city

1960s Pittsburgh was a racially divided city, with blacks and whites living in largely segregated neighborhoods. The center of the black community — a traditional first stop for immigrants including Syrians, Jews and Italians — as the Hill District.

In the ’50s, in a misguided effort at urban renewal, the city had demolished hundreds of homes and businesses there to make way for a new sports arena and office buildings, displacing families and breeding resentment that lingered for decades. Unemployment and poverty were rampant. Emergency medical response in Pittsburgh, even by the standards of the time, was woefully out of date. Emergency response was left up to police, who responded in Suburbans or cargo-type vans with a bench and space for a military-style stretcher in the rear, and precious little else. Other medical transports were handled by private ambulances operated by funeral homes.

Yet the funeral homes often weren’t willing to respond to black neighborhoods, says Gene Starzenski, who at the time worked for an ambulance company in Pittsburgh. And residents in black neighborhoods couldn’t necessarily count on police.

Take the case of Mitchell Brown, who was 17 when his mother, 35-years-old and raising two children on her own, suffered a cerebral hemorrhage in their Hill District home.

“We called the police to come and take care of her,” recalls Brown, who years later became a Freedom House medic. “The two white police officers refused to carry her — they said she was drunk. I carried her myself and put her in the paddy wagon. We took her to St. Francis Hospital. I never saw her alive again.”

Riots break out

The dismal state of emergency medical response in Pittsburgh gained notoriety in November 1966, when a former Pittsburgh mayor who had gone on to become governor collapsed from a heart attack during a speech at a local mosque. Police officers whisked him to the hospital, but he didn’t survive.

“People came to realize this system was not only outdated, but medically dangerous and lethal,” says Phil Hallen, a Yale School of Public Health graduate who was president of the Maurice Falk Medical Fund, a foundation that supported job-building initiatives.

As a doctoral student at Syracuse University in the ’50s, Hallen drove a hearse-style ambulance.

“I saw how desperately untrained everybody was,” he says.

After the governor’s death, Hallen saw an opportunity. He approached James McCoy Jr., a local steelworkers union leader and community activist who had established the Freedom House Enterprise Corporation to foster black-owned businesses. To Hallen, an ambulance service could provide jobs for locals — for responders, managers and mechanics to maintain the ambulances — and improve medical care in the community. McCoy quickly got on board.

“One of the really pressing needs was transportation,” Hallen says. “People simply couldn’t get to hospitals.”

Seeking medical direction

A nurse who had been trained by Safar in the latest resuscitation techniques happened to be in the audience when the governor collapsed. She tried to do chest compressions as the police vehicle sped to the hospital, but she couldn’t perform them effectively, bouncing around in the back of the vehicle, Hallen says.

Safar, a professor at the University of Pittsburgh and chief of anesthesiology at Presbyterian-University Hospital (now UPMC Presbyterian), was already gaining national renown for his work in resuscitation. In 1966, Safar and his wife, Eva, had suffered a terrible tragedy when their 11-year-old daughter Elizabeth, who was born prematurely, died of a severe asthma attack.

According to a 2002 interview with Safar in the Pittsburgh Post-Gazette, his daughter’s lungs and heart were salvageable, but her brain had gone without oxygen for too long, leaving her in a coma. She died after three days in the hospital. The loss of his child fueled Safar’s determination to improve emergency and critical care.

“He was training as many people at the hospital in CPR as he could get his hands on,” Hallen says.

The publicity around the governor’s death gave Safar a platform to share his recommendations about the need for better pre-hospital care, but he still didn’t have a way to carry out broad training, Hallen says. When Hallen approached him about the ambulance company, Safar was enthusiastic.

“He said ‘I’ve been looking for a way to demonstrate to the world that you can train people who are not nurses or other professionals to do CPR and be first-rate medical technicians,’” Hallen recalls.

At the city, Hallen, Safar and McCoy found a receptive audience in Moe Coleman, a professor of social work at the University of Pittsburgh who worked in the mayor’s office. With President Johnson’s War on Poverty driving national interest in anti-poverty programs, the city agreed to contract with Freedom House to provide emergency response to the Hill and downtown Pittsburgh.

“Phil [Hallen] and I were good friends. He came up with an idea that seemed to be really remarkable,” says Coleman, now director emeritus of the university’s Institute of Politics. “It provided good medical care in places that weren’t getting it. It involved Dr. Safar, a brilliant doctor who was creative in his ideas on how to restructure the ambulance system so the vehicle could become a treatment center rather than transportation. And, thirdly, there was an opportunity to train African-American men and women for a profession that was important.”

Recruiting trainees

Most of the first class of Freedom House recruits were unemployed. Some were returning Vietnam vets struggling with drugs and alcohol. Some were recruited off the streets when they didn’t get enough people initially, says Starzenski, who made a documentary about Freedom House.

Safar led the training, which consisted of 300 hours of education over nine or more months at various hospitals in Pittsburgh, including Presbyterian-University Hospital. They did rotations in the emergency room, operating room, obstetrics, X-ray and the morgue.

“They got an unprecedented medical education,” Hallen says. “At the same time, some were taking GED exams.”

John Moon recalls Safar teaching him to intubate.

“He was the chief anesthesiologist,” he says. “He would go into an operating room. An anesthesiologist would be sitting at the head of the patient, ready to intubate. The surgeon was there, all gloved up, ready to do his surgery. Safar would come in to the OR, move the anesthesiologist out of the way, sit me at the head of the patient and say, ‘Intubate this patient,’ while the patient’s physician was standing there waiting.

“I was terrified,” Moon adds. “But Safar believed, what better way to train you to do something than under pressure? We went from room to room doing it. If you had taken forever to put a tube down a patient’s trachea, the patient would start moving from a lack of oxygen. So we moved fast.”

Freedom House’s first big test came following the assassination of Martin Luther King Jr. on April 4, 1968. Riots broke out in the Hill District and in other major U.S. cities. With buildings burning and rioters looting stores, Freedom House medics, who had gone with Safar for training at Baltimore City Hospital (now Johns Hopkins), immediately headed home.

For three weeks, they worked with the largely white police force to provide emergency care to the injured. The medics didn’t yet have their own vehicles, Starzenski says, so they rode in the police vehicles with a light on at night.

“They wanted them to see there were black people in the vehicle so they didn’t get shot at,” Starzenski says. “They went out in the neighborhoods and said, ‘We’re here to help you.’”

The National Guard was eventually called in and a curfew set. Yet after the riots died down, Pittsburgh still had a long way to go in erasing a longstanding history of racism.

Seeking respect

Even as Freedom House medics gained respect among residents of the Hill District, they continued to battle the stigma that the medics were “unemployables” taking part in an anti-poverty program, Moon says. Starzenski, working as a hospital orderly in the early ’70s, recalls asking a white employee about the Freedom House medics. The man called them a racial epithet.

“I knew that was bullsh**,” Starzenski says. “I looked in the back of the ambulance and saw the equipment. They had defibrillators and monitors. These guys were doing things that no one else was.”

In 1974, Safar appointed Nancy Caroline, M.D., as the medical director for Freedom House. Like Safar, she took the providers’ medical education seriously.

“Try to imagine this woman, walking through the door in an ICU, an area off-limits to anybody else, with six African-Americans, going right to a patient’s bed and having us listen to lung sounds and check the IV, without saying anything to anybody,” Moon recalls. “Can you imagine the looks? She broke that barrier down.”

Yet earning respect was an ongoing battle, he adds.

“I remember we picked this patient up, put him on the monitor, started a line, got him to the emergency room,” Moon says. “We saw a nurse. I started rattling off his medical information — age, past medical history, monitor readings — things that are standard today. And the nurse laughed and walked away. I didn’t expect that. So I found a physician in the ER and it was received 10 times better. I went back to Nancy Caroline and said, ‘I don’t know why we prepared all of this information and rehearsed how to deliver it if they’re not going to listen to me.’”

Caroline told him to keep at it.

“If you don’t learn to speak the lingo of the emergency department, no one will ever listen to you,” she said. “Don’t allow that to be a stumbling block to what you’re supposed to do and what you’re here for.”

Caroline often rode with crews and held weekly staff meetings to critique performance on serious or complex calls.

“The crew would have to stand up and present that call to the rest of the staff and discuss what we did, what the outcome was, why we didn’t do certain things, what we should have done, and come up with what would be the best possible way to have handled that call,” Moon says. “She was about five feet tall,” he adds. “We had the utmost respect for her but we also feared her.

Freedom House medics carried battery-powered ECGs that charged in the ambulance using an inverter.

“We were the first to introduce telemetry to a hospital. We would send an EKG strip to the hospital over the radio,” Moon says. “They had a base station next to the radio they talked to us on, and they could confirm what we were seeing ... Freedom House was the proving ground for a lot of the things that are standard today.”

Demand grows for EMS

In the early ’70s, one of Freedom House’s greatest achievements also contributed to its undoing. A boy riding a bike was struck by a bus in a more affluent section of the city; his leg was badly mangled. Police got on the radio and called Freedom House.

“They said, ‘We want somebody out here who knows what they’re doing,’” Moon recalls. “Our first response was, ‘That’s not our district,’ but we went anyway.”

Freedom House medics splinted the leg, started an IV and took the boy to the hospital.

“Word got around that an EMS service came out here and they were responsible for saving this kid’s life,” Moon says.

That led to residents outside the Hill District to loudly question why only downtown and the Hill District had emergency response by trained technicians, while they were still relying on police and funeral homes.

In 1975, a newly elected mayor decided he would no longer contract with Freedom House and replaced it with a city-run ambulance service. Freedom House had always eked by on grants; on more than one occasion, they had trouble making payroll, Starzenski says. Without the city contract, they could no longer continue to operate. Freedom House ran its last call in 1975, an elderly woman in the Hill who had broken her hip, recalls Mitchell Brown, who was one of the responders.

A lifetime of service

Some of those who worked for Freedom House drifted away from the profession; one Freedom House medic drives a cab. Others took jobs with the city-run ambulance service and remained in EMS for decades to come.

Darnella Wilson was one of the last to join Freedom House after graduating from high school in 1975. She started as a dispatcher, then ran her first call to the home of an elderly woman who was hoarding garbage and unable to care for herself.

“It was deplorable,” Wilson recalls. “It smelled really bad. And she was pretty mean. I was in shock that somebody could live like that. I got back to the dispatch center and I was thinking, I’m going to go straight to school [at the University of Pittsburgh]. I don’t think I want to do this.”

Later, they got another call for the same address.

“They said, ‘Let’s go.’ And I was saying, ‘No, no, no. I can’t go back there.’” Eventually, Wilson relented, stuffing cotton up her nose to mask the odor. This time, Freedom House medics were able to persuade the woman to allow them to take her for medical help.

“I saw that they really helped that woman. That was pretty compassionate,” Wilson recalls. “I thought, maybe I will see how this works out.”

Wilson was hired by the city, where she worked for more than 35 years. Along the way, she became an R.N. For several years she worked two jobs — a day shift at the hospital and a night shift on the ambulance. But she preferred working as a medic and eventually went back to that full-time. Along the way, she raised a daughter and her brother’s three children.

In 1999, Wilson was featured in the TLC series “Paramedics.” In one scene, she’s riding in the ambulance, talking to her children on a cell phone the size of a brick.

“You can hear me saying, ‘You’re going to after-school care, or I will turn this truck around and come get you,’” she recalls with a chuckle.

A fresh start

After losing his mother at age 17, Brown went to college in Detroit, then enlisted in the Air Force, where he became a medic. Upon discharge, he returned home to the Hill District. After seeing Freedom House ambulances in his neighborhood, he headed to Safar’s office at the hospital to ask him for a job. Safar hired him on the spot.

“I fell in love with the concept of providing prehospital emergency care to the black community,” Brown says.

After the city took over EMS, Brown went to work for the university. He later became EMS commissioner in Cleveland. After several other stops in city and state government, including running the Ohio lottery, he became public safety director for the Columbus, Ohio, Department of Public Safety in 2000.

He credits Freedom House with giving him his start.

“I had no appreciation for the sheer magnitude of what we were doing at the time,” Brown says. “The people in the community had a sense of pride in the quality of service we were providing them, and so did we.”

New recognition

For decades, no one talked much about the Freedom House medics. Then in 2001, Starzenski, who had moved to Los Angeles and was working as a medic on movie sets, decided to head back to Pittsburgh and learn what had become of the Freedom House medics.

“It was always in my heart to tell that story,” he says.

Starzenski uncovered old photos and documents. He conducted interviews with former medics, with Safar before his death in 2003 and with Nancy Caroline’s mother. Caroline died at age 58 of cancer.

Spending tens of thousands of his own savings, he created his documentary, Freedom House: Street Saviors, and in 2010, it was ready for release. Development deals for the documentary never panned out, however; as of now, the documentary has mainly been shown at EMS conventions. Whether the story of Freedom House will ever reach a wide audience remains unknown.

Yet Freedom House and its responders are increasingly occupying a hallowed place in EMS history. In August, the National Highway Traffic Safety Administration awarded a Public Service Award to the Freedom House Ambulance Service. Several former medics attended the ceremony.

And Freedom House is inspiring new efforts to extend EMS job opportunities to low-income young people. In 2009, the St. Paul (Minn.) Parks and Recreation Department Youth Job Corps, Inver Hills Community College, the St. Paul Human Rights and Equal Economic Opportunity Department and the St. Paul Fire Department came together to start an innovative new program: Use Job Corps grant money to pay low-income young people $7.50 an hour to become EMTs.

“When we started the program, some of the things we ran into we’d never envisioned,” says St. Paul Fire Chief Tim Butler, who has worked with social services to get the EMT students the resources they needed. “Some needed to know the bus schedule so they could get there, or how to get daycare for the kids because they were single moms, or needed eyeglasses so they could read the EMT book.”

More than 100 young men and women — some of whom were in the foster system or homeless when they entered the program — have become certified EMTs. Classes are held in a vacant fire station that was converted into classrooms and training areas. To help in job placement and help make the program self-sustaining, in 2011, the St. Paul Fire Department also started a BLS scheduled transport service, staffed by the Job Corps EMT graduates.

After hearing about the parallels between the young medics of Pittsburgh in the ’60s and their new crop of EMTs, the folks in St. Paul decided to name their service St. Paul Fire Department’s Freedom House Station 51. Starzenski and several former Freedom medics have gone to Minnesota to screen the documentary and meet with the young EMTs.

“I’m glad we have over 100 new medics in Minneapolis-St. Paul because of Freedom House,” Starzenski says. “That’s what I’m more proud of than anything. It’s paying it forward.”

About the author

Produced in partnership with NEMSMA, Paramedic Chief: Best Practices for the Progressive EMS Leader provides the latest research and most relevant leadership advice to EMS managers and executives. From emerging trends to analysis and insight, practical case studies to leadership development advice, Paramedic Chief is packed with useful, valuable ideas you simply can’t get anywhere else.

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